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Health Plans Seek Supreme Court Review in ACA "Risk Corridors" Cases

Client Alert | 1 min read | 02.12.19

On February 4, several health plans (including C&M client Maine Community Health Options) filed petitions for certiorari at the U.S. Supreme Court, seeking review of the Federal Circuit’s opinion in the ACA “risk corridors” cases, which held that while the risk corridors program contained a mandatory payment obligation on the part of the Government, that payment obligation was temporarily suspended by appropriations riders that restricted HHS funds available to satisfy the obligation, even though the riders did not amend or repeal the statutory payment obligation and even though the health plans had already performed their own reciprocal obligations under the statute. The petitioners are seeking review of the Federal Circuit’s opinion on several grounds, including (i) the restriction of funds to an agency via appropriations rider does not extinguish a statutory payment obligation of the United States, (ii) a rider that does not by its terms repeal or amend a money-mandating statute cannot impliedly and retroactively extinguish the Government’s payment obligation. The Maine petition is linked here. 

Insights

Client Alert | 2 min read | 03.27.26

CMS Releases PY 2020 RADV Audit Methods and Instructions: Key Takeaways for Health Plans

On March 20, 2026, the Centers for Medicare and Medicaid Services (CMS) released new guidance outlining the agency’s audit methods and instructions for Medicare Advantage (MA) plans subject to upcoming risk adjustment data validation (RADV) audits for payment year (PY) 2020. In addition to providing necessary context for MA plans selected for auditing, this resource clarifies CMS’s methodological and procedural expectations. While the high-level takeaways are recapped below for convenience, we strongly recommend that MA organizations selected for PY 2020 audits closely review the guidance to understand what may be involved — or required — during the agency’s review....